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Suh Y, Shin S, Kim BY, Jeong J, Kim TI. Comparison of neck angle and musculoskeletal discomfort of surgeon in cataract surgery between three-dimensional heads-up display system and conventional microscope. Sci Rep 2024; 14:22681. [PMID: 39349516 PMCID: PMC11442983 DOI: 10.1038/s41598-024-68630-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/25/2024] [Indexed: 10/02/2024] Open
Abstract
The three-dimensional heads-up display system (3D HUDS) is increasingly utilized by ophthalmologists and suggested to offer ergonomic benefits compared to conventional operating microscopes. We aimed to quantitatively assess the surgeon's neck angle and musculoskeletal discomfort during cataract surgery using commercially available 3D HUDS and conventional microscope. In this single-center comparative observational study, the surgeon conducted routine phacoemulsification surgeries using Artevo® 800 and Opmi Lumera® 700 (both from Carl Zeiss Meditec, Jena, Germany). The surgeon's intraoperative neck angle was measured using the Cervical Range of Motion device. Postoperative musculoskeletal discomfort was assessed using the Visual Analog Scale (VAS) score after each surgery. A total of 80 cataract surgeries were analyzed, with 40 using Artevo® 800 and 40 using Opmi Lumera® 700. The neck angle was extended when using Artevo® 800 and flexed when using Opmi Lumera® 700 during continuous curvilinear capsulorhexis (CCC), phacoemulsification, and intraocular lens (IOL) placement (- 8.18 ± 2.85° vs. 8.27 ± 2.93° in CCC, - 7.83 ± 3.30° vs. 8.87 ± 2.83° in phacoemulsification, - 7.43 ± 3.80° vs. 7.67 ± 3.73° in IOL placement, respectively; all p < 0.001). The VAS score was significantly lower in surgeries performed with Artevo® 800 (1.27 ± 0.55 vs. 1.73 ± 0.64, p < 0.001). The findings suggest that 3D HUDS help reduce neck flexion and lower work-related musculoskeletal discomfort through ergonomic improvements.
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Affiliation(s)
- Youngsong Suh
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Suyoung Shin
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Bo Yi Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jiwon Jeong
- Fatima Eye Clinic, 320 Woni-daero, Seongsan-gu, Changwon-si, Gyeongsangnam-do, 51408, Republic of Korea.
| | - Tae-Im Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Varman A, Varman NVA, Balakumar D. Assessing the surgical competency of novice surgeons by using a three-dimensional heads-up display microscope. Indian J Ophthalmol 2024; 72:1329-1335. [PMID: 38990609 DOI: 10.4103/ijo.ijo_2677_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/27/2024] [Indexed: 07/12/2024] Open
Abstract
PURPOSE To evaluate the surgical performance of novice surgeons operating on a three-dimensional (3D) heads-up display system compared to those using a traditional microscope (TM). METHODS Prospective study design in a private practice setting. Twenty novice surgeons with similar experiences in cataract surgery were selected. Each surgeon performed 20 phacoemulsification cataract surgeries: 10 surgeries on the 3D heads-up display microscope, and 10 surgeries using a TM system. Data were collected from a total of 400 patients operated on by 20 surgeons. Outcome measures were recorded and graded according to the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric-Phacoemulsification system. The main outcome measure was mean surgical competency scores. RESULTS Overall, 400 data points were equally distributed between TM (200) and 3D (200) surgeries. The mean surgical competency scores were 60.19 (11.41) for TM surgeries and 62.99 (11.11) for 3D surgeries. 3D surgeries had significantly higher surgical competency scores than TM surgeries ( P = 0.013). The mean surgical duration for TM and 3D surgeries was 35.98 (6.02) min and 34.31 (7.12) min, respectively. 3D surgeries took significantly less time than TM surgeries ( P = 0.012). The overall mean best corrected visual acuity in the logarithm of the minimum angle of resolution units was 0.27 (0.42); in TM and 3D surgeries, it was 0.28 (0.43) units and 0.26 (0.41) units, respectively. CONCLUSION The 3D heads-up display system enhances stereopsis in cataract surgery, making it a valuable training tool for novice surgeons in phacoemulsification procedures.
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Affiliation(s)
| | | | - Dinesh Balakumar
- Department of Cataract and Refractive Surgery, Uma Eye Clinic, Chennai, Tamil Nadu, India
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Rosenberg ED, Shah LS, Sippel KC, Nattis AS. Light as a drug: prospective randomized evaluation and comparison of the effect of decreased illumination on visual recovery after cataract surgery. J Cataract Refract Surg 2024; 50:468-473. [PMID: 38127859 PMCID: PMC11045462 DOI: 10.1097/j.jcrs.0000000000001384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/06/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To compare the effect of decreased illumination on the rate of postoperative visual recovery, and the incidence of cystoid macular edema (CME) with surgical visualization achieved with a traditional analog operating microscope compared with a 3D digital visualization system. SETTING Ambulatory surgery center, New York. DESIGN Prospective, randomized, consecutive, single-surgeon series. METHODS Patients undergoing routine cataract surgery were randomized into either (1) visualization through the binoculars of a standard operating microscope ("traditional group") or (2) visualization through a 3D digital visualization system affixed to the same operating microscope ("digital group"). Note was made in each case of light intensity used, light exposure time, cumulative dissipated energy (CDE), femtosecond laser use, preoperative medical and ocular conditions, intraoperative and/or postoperative complications, and preoperative and postoperative visual acuities and optical coherence tomography confirmed CME. RESULTS The study comprised 118 eyes in the traditional group and 96 eyes in the digital group. There were no differences in preoperative visual acuity, light exposure time, CDE, or femtosecond laser use between groups, but the light intensity used in the digital group was significantly less (19.5% ± 0.5%) than in the traditional group (48.6% ± 0.6%; P < .001). Furthermore, the digital group achieved a better decimal postoperative day 1 visual acuity (0.60 ± 0.03) with less rates of CME (2.1%) when compared with that of the traditional group (0.51 ± 0.02, P = .03; and 9.2%, P = .03), respectively. CONCLUSIONS Visual recovery and CME rates were significantly better in patients who underwent cataract surgery assisted by the 3D digital visualization platform without an increase in complications or surgical time.
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Affiliation(s)
- Eric D. Rosenberg
- From the Department of Ophthalmology, New York Medical College, Valhalla, New York (Rosenberg, Shah); Department of Ophthalmology, Weill Cornell Medical College, New York, New York (Sippel); Department of Ophthalmology, SightMD, New York, New York (Nattis)
| | - Lopa S. Shah
- From the Department of Ophthalmology, New York Medical College, Valhalla, New York (Rosenberg, Shah); Department of Ophthalmology, Weill Cornell Medical College, New York, New York (Sippel); Department of Ophthalmology, SightMD, New York, New York (Nattis)
| | - Kimberly C. Sippel
- From the Department of Ophthalmology, New York Medical College, Valhalla, New York (Rosenberg, Shah); Department of Ophthalmology, Weill Cornell Medical College, New York, New York (Sippel); Department of Ophthalmology, SightMD, New York, New York (Nattis)
| | - Alanna S. Nattis
- From the Department of Ophthalmology, New York Medical College, Valhalla, New York (Rosenberg, Shah); Department of Ophthalmology, Weill Cornell Medical College, New York, New York (Sippel); Department of Ophthalmology, SightMD, New York, New York (Nattis)
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Jeon HS, Kim MH, Joo K, Park SJ, Lee EJ, Hyon JY, Kim TW, Park KH, Woo SJ. Comparison of posterior capsule rupture rates during phacoemulsification using 3D heads-up visualization system and traditional microscopes. J Cataract Refract Surg 2024; 50:328-332. [PMID: 37919836 DOI: 10.1097/j.jcrs.0000000000001357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/27/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE To compare the posterior capsule rupture (PCR) rates of cataract surgery using a traditional ophthalmic surgical microscope (OSM) and a 3D heads-up visualization system (HUVS). SETTING Single tertiary referral center. DESIGN Retrospective study. METHODS This study included 10 101 eyes that underwent phacoemulsification cataract surgery. Surgeries were performed using either 3D HUVS (1964 eyes, performed by 2 surgeons, HUVS group) or traditional OSM (8137 eyes, performed by 6 surgeons, OSM group) from February 2018 to June 2022. Data were collected based on the diagnosis-related group system, and the rate of PCR requiring vitrectomy and the surgical time were evaluated. RESULTS The PCR rates were not significantly different between the OSM (n = 63; 0.7%) and HUVS (n = 19; 0.9%, P = .392) groups. The mean surgical time was significantly longer in the HUVS group (14.7 ± 10.6 minutes) than in the OSM group (12.9 ± 9.9 minutes, P < .001). In the 3D HUVS group, there were no PCR cases among the initial 100 patients. In both groups, no significant difference was observed in the PCR rates over time. Although the difference was not statistically significant, the PCR rate decreased over time in the HUVS group. CONCLUSIONS The results indicate that 3D HUVS-based cataract surgery performed by experienced cataract surgeons had a PCR rate similar to that of traditional OSM-based surgery during the 4-year study period. Although the surgical time was slightly longer with 3D HUVS, cataract surgery using 3D HUVS can be performed safely by experienced surgeons.
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Affiliation(s)
- Hyun Sun Jeon
- From the Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea (Jeon, M.H. Kim, Joo, S.J. Park, Lee, Hyon, T.-W. Kim, K.H. Park, Woo); Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea (Jeon, Joo, S.J. Park, Lee, Hyon, T.-W. Kim, K.H. Park, Woo); Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea (K.H. Park)
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Zhao XY, Zhao Q, Li NN, Wang CT, Wang YH, Meng LH, Min HY, Chen YX. Comparison of three-dimensional heads-up system versus traditional microscopic system in medical education for vitreoretinal surgeries: a prospective study. BMC MEDICAL EDUCATION 2024; 24:290. [PMID: 38491487 PMCID: PMC10943918 DOI: 10.1186/s12909-024-05233-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 02/27/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND To compare the value and efficiency of the three-dimensional (3D) heads-up surgical system and traditional microscopic (TM) system in teaching and learning vitreoretinal surgeries. METHODS Twenty ophthalmologists and scrub nurses were recruited as teachers, and 45 junior ophthalmology residents and trainee doctors, trainee nurses, and medical students were recruited as observers. Each teacher and observer were assigned to both a 3D-assisted and TM-assisted vitreoretinal surgery and then asked to complete satisfaction questionnaires for both surgical systems at the end of each surgery. RESULTS The 3D heads-up surgical system was rated significantly higher in most of the subscales and overall satisfaction score by both teachers and observers (P < 0.05). However, ratings for instrument adjustment were significantly higher in the TM group compared to the 3D group for junior ophthalmology residents and trainee doctors (6.1 ± 1.7 vs. 8.8 ± 1.1, P < 0.001). CONCLUSIONS The 3D heads-up surgical system has great didactical value in the medical education of vitreoretinal surgeries, but it is important to consider the specific needs of different learners when choosing between the two systems. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Xin-Yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, 100730, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qing Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, 100730, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ning-Ning Li
- Department of Operating Room, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chu-Ting Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, 100730, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yin-Han Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, 100730, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Li-Hui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, 100730, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Han-Yi Min
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, 100730, Beijing, China.
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - You-Xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, 100730, Beijing, China.
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Rosenberg ED, Shah LS, Sippel KC, Nattis AS. Reply: Light as a drug: prospective randomized evaluation and comparison of the effect of decreased illumination on visual recovery following cataract surgery. J Cataract Refract Surg 2024; 50:315-316. [PMID: 38270477 PMCID: PMC10878444 DOI: 10.1097/j.jcrs.0000000000001402] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Affiliation(s)
- Eric D. Rosenberg
- From the Department of Ophthalmology, New York Medical College, Valhalla, New York (Rosenberg, Shah); Department of Ophthalmology, Weill Cornell Medical College, New York, New York (Sippel); Department of Ophthalmology, SightMD, New York, New York (Nattis)
| | - Lopa S. Shah
- From the Department of Ophthalmology, New York Medical College, Valhalla, New York (Rosenberg, Shah); Department of Ophthalmology, Weill Cornell Medical College, New York, New York (Sippel); Department of Ophthalmology, SightMD, New York, New York (Nattis)
| | - Kimberly C. Sippel
- From the Department of Ophthalmology, New York Medical College, Valhalla, New York (Rosenberg, Shah); Department of Ophthalmology, Weill Cornell Medical College, New York, New York (Sippel); Department of Ophthalmology, SightMD, New York, New York (Nattis)
| | - Alanna S. Nattis
- From the Department of Ophthalmology, New York Medical College, Valhalla, New York (Rosenberg, Shah); Department of Ophthalmology, Weill Cornell Medical College, New York, New York (Sippel); Department of Ophthalmology, SightMD, New York, New York (Nattis)
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Shetty N, Aishwarya, Nayak RP, Kaweri L, Kanaradi RK, Pisharody AA. 3D visualization system and standard operating microscope for ease of visualization and surgeon comfort during phacoemulsification surgery. Indian J Ophthalmol 2024; 72:56-62. [PMID: 38131570 PMCID: PMC10841793 DOI: 10.4103/ijo.ijo_1332_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/27/2023] [Accepted: 08/10/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To compare the ease of visualization and comfort of the surgeon during phacoemulsification surgery using NGENUITY® 3D (NG) visualization system and standard operating microscope (SOM). METHODS In this prospective, randomized, single-blind, single-center study, patients undergoing phacoemulsification surgery by one of the five surgeons were randomly assigned to two groups based on the visualization modality-NG and SOM. Ease of visualization and comfort of the surgeon was assessed using a 27-parameter in-house Surgeon Comfort Score questionnaire. RESULTS A total of 224 phacoemulsification with intraocular lens implantations were performed in senile immature cataract (SIMC, n = 174) and mature cataract patients (MC, n = 50). Surgeon's ease of visualization (4.92-5.00) and hand-eye coordination score (4.97-5.00) were comparable between the NG- and SOM-groups. Postoperative neck discomfort was lower in both the groups, with a relatively lower discomfort in the NG-group (score: 1.04 vs 1.56). The Spearman rank correlation coefficient (r) between illumination of the operation theatre room and the surgical field revealed a weak negative correlation for most of the patients in the NG-group, and a positive correlation for patients in the SOM-group. No correlation was obtained between brightness of the surgical field and comfort with the surgical field brightness. CONCLUSIONS Similar ease of visualization was experienced by the surgeons using NG- and SOM-system. Neck discomfort postsurgery was numerically lower in the NG-group, although not significant. Additionally, the NG-system permitted the safe performance of phacoemulsification using a lower surgical field illumination.
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Affiliation(s)
- Naren Shetty
- Cataract Department, Narayana Nethralaya, Rajajinagar, Bengaluru, Karnataka, India
| | - Aishwarya
- Cataract Department, Narayana Nethralaya, Rajajinagar, Bengaluru, Karnataka, India
| | - Rohitha P Nayak
- Cataract Department, Narayana Nethralaya, Rajajinagar, Bengaluru, Karnataka, India
| | - Luci Kaweri
- Cataract Department, Narayana Nethralaya, Rajajinagar, Bengaluru, Karnataka, India
| | | | - Anchana A Pisharody
- Imaging Biomechanics and Mathematical Modelling Solutions Lab, Narayana Nethralaya, Bommasandra, Bengaluru, Karnataka, India
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Srinivasan S, Tripathi AB, Suryakumar R. Evolution of operating microscopes and development of 3D visualization systems for intraocular surgery. J Cataract Refract Surg 2023; 49:988-995. [PMID: 37144641 DOI: 10.1097/j.jcrs.0000000000001216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/02/2023] [Indexed: 05/06/2023]
Abstract
The recent development of high-resolution, heads-up, 3D visualization microscopy systems has provided new technical and visualization options for ophthalmic surgeons. In this review, we explore the evolution of microscope technologies, the science behind modern 3D visualization microscopy systems, and the practical benefits (as well as disadvantages) that these systems provide over conventional microscopes for intraocular surgical practice. Overall, modern 3D visualization systems reduce the requirements for artificial illumination and provide enhanced visualization and resolution of ocular structures, improving ergonomics, and facilitating a superior educational experience. Even when considering their disadvantages, such as those related to technical feasibility, 3D visualization systems have an overall positive benefit/risk ratio. It is hoped these systems will be adopted into routine clinical practice, pending further clinical evidence on the benefits they may provide on clinical outcomes.
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Affiliation(s)
- Sathish Srinivasan
- From the University Hospital Ayr, Ayr, Scotland, United Kingdom (Srinivasan); University of West of Scotland, Ayr, Scotland, United Kingdom (Srinivasan); Alcon Research LLC, Fort Worth, Texas (Tripathi, Suryakumar)
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Wang Y, Hu Y, Zhang R, Wang Z, Zhang G, Chen W, Ma JX, Wang D, Ye X. Evaluation of new approach to enhance visualization performance in cataract surgery: 3D visualization system with coaxial illumination. J Cataract Refract Surg 2023; 49:912-916. [PMID: 37350761 DOI: 10.1097/j.jcrs.0000000000001232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/30/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE To evaluate the visualization performance of different approaches, including the 3D visualization system with coaxial illumination and the 3D system or microscope with standard illumination. SETTING Fuzhou Eye Hospital, Fuzhou City, China. DESIGN Cross-sectional study. METHODS This 2-part performance assessment for visualization composed of an objective analysis using surgical video images and a subjective survey collecting feedback from surgeons. Data of each eye were obtained with 3 approaches: standard operating microscope with standard illumination (SOM-S), 3D visualization system with standard illumination (3D-S), and 3D visualization system with coaxial illumination (3D-C). RESULTS 112 eyes (107 cases) and 6 cataract surgeons were involved. The red reflex value was markedly greater in the 3D-C approach compared with other 2 approaches ( P < .001). Compared with the SOM-S approach, the red reflex increased by 55%, 57%, and 53% in the 3D-C approach, corresponding to nuclear grades of II, III, and IV, respectively. In the questionnaire survey, red reflex scores were consistently significantly higher in the 3D-C approach than those in the others ( P < .001). Depth of field was enhanced in both 3D approaches compared with the SOM-S approach ( P < .05). The only minor advantage of the SOM system over the 3D-C approach was in the surrounding field clarity score, and the difference was not statistically significant ( P = 1.000). CONCLUSIONS The 3D-C approach significantly increased the red reflex in both objective and subjective assessments. Surgeon responses also showed a superior performance for the 3D-C approach.
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Affiliation(s)
- Yan Wang
- From the Fuzhou Eye Hospital, Fuzhou City, China (Y. Wang, Hu, R. Zhang, Z. Wang, Ye); Xiamen Eye Center, Xiamen University, Xiamen City, China (G. Zhang, Chen, Ye); Ruiz Department of Ophthalmology & Visual Science, McGovern Medical School at University of Texas Health Houston, Texas (Ma); Jinan Huashi Eye Hospital, Jinan, China (D. Wang)
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Gualino V, Pierne K, Manassero A, Bruneau S, Couturier A, Tadayoni R. Comparing microscope light-associated glare and comfort between heads-up 3D digital and conventional microscopes in cataract surgery: a randomised, multicentre, single-blind, controlled trial. BMJ Open Ophthalmol 2023; 8:e001272. [PMID: 37493673 PMCID: PMC10314628 DOI: 10.1136/bmjophth-2023-001272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/27/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE To compare subjective levels of comfort and visual experiences related to microscope light in patients undergoing their first cataract surgery with topical anaesthesia using a digital microscope (the NGENUITY three-dimensional (3D) visualisation system) or a conventional microscope. METHODS AND ANALYSIS A prospective, randomised, single-blinded, parallel-group, multicentre, interventional study. Patients (n=128) were randomly assigned to one of two treatment groups: the experimental group (n=63) had surgery using the digital microscope and the control group (n=65) had surgery with a conventional microscope. The primary outcome was patients' subjective experience of glare from the microscope light during surgery on a numerical scale from 0 to 10. Key secondary outcomes were patients' subjective levels of comfort and visual experiences related to the microscope light. RESULTS The experimental group reported significantly lower levels of glare; median levels were 1.0 (0.0-4.0) for the experimental group vs 3.0 (0.0-6.0) for the control group (p=0.027). They also reported higher levels of comfort; median ratings were 8.0 (6.5-10.0) in the experimental group and 7.0 (5.0-9.0) in controls (p=0.026). There were no group differences in ratings of subjective pain or visual disturbances. Median microscope light intensity was lower in the experimental group than controls; 3425.0 (2296.0-4300.0) Lux vs 24 279.0 (16 000.0-26 500.0) Lux (p<0.0001), respectively. CONCLUSION Compared with conventional microscopes, the NGENUITY 3D visualisation system allows surgeons to operate with lower levels of light exposure, resulting in significantly less glare and improved comfort in patients undergoing cataract surgery. TRIAL REGISTRATION NUMBER NCT05085314.
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Affiliation(s)
- Vincent Gualino
- Department of Ophthalmology, Clinique Honoré Cave, Montauban, France
| | - Kevin Pierne
- Department of Ophthalmology, Clinique Honoré Cave, Montauban, France
| | - Anthony Manassero
- Department of Ophthalmology, Hôpital Fondation Adolphe De Rothschild, Paris, France
| | - Sébastien Bruneau
- Department of Ophthalmology, Hôpital Fondation Adolphe De Rothschild, Paris, France
| | - Aude Couturier
- Department of Ophthalmology, Université Paris Cité, AP-HP, Hôpital Lariboisière, Paris, France
| | - Ramin Tadayoni
- Department of Ophthalmology, Hôpital Fondation Adolphe De Rothschild, Paris, France
- Department of Ophthalmology, Université Paris Cité, AP-HP, Hôpital Lariboisière, Paris, France
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Giansanti F, Nicolosi C, Bacherini D, Soloperto F, Sarati F, Giattini D, Vicini G. Three-Dimensional Visualization System for Vitreoretinal Surgery: Results from a Monocentric Experience and Comparison with Conventional Surgery. Life (Basel) 2023; 13:1289. [PMID: 37374072 DOI: 10.3390/life13061289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE To describe the experience of our centre (Careggi University Hospital, Florence, Italy) in using a heads-up three-dimensional (3D) surgical viewing system in vitreoretinal surgery, making a comparison with the conventional microscope surgery. METHODS We retrospectively analyzed data taken from 240 patients (240 eyes) with surgical macular diseases (macular hole and epiretinal membrane), retinal detachment or vitreous hemorrhage who underwent vitreoretinal surgeries, by means of the NGENUITY 3D Visualization System (Alcon Laboratories Inc., Fort Worth, TX, USA), in comparison with 210 patients (210 eyes) who underwent vitreoretinal surgeries performed using a conventional microscope. All surgeries were performed with standardized procedures by the same surgeons. We analyzed data over a follow-up period of 6 months, comparing the surgical outcomes (best-corrected visual acuity, anatomical success rate and postoperative complication rate) between the two groups. RESULTS the 3D group included 74 patients with retinal detachment, 78 with epiretinal membrane, 64 with macular hole and 24 with vitreous hemorrhage. There were no significant differences in the demographic and clinical characteristics between the 3D group and the conventional group. We found no significant differences in outcome measures at three and six months follow-up between the two groups (p-value ≥ 0.05 for all comparisons). Surgery durations were similar between the two groups. CONCLUSIONS In our experience, a heads-up 3D surgical viewing system provided comparable functional and anatomical outcomes in comparison with conventional microscope surgery, proving to be a valuable tool for vitreoretinal surgery in the treatment of different retinal diseases.
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Affiliation(s)
- Fabrizio Giansanti
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Cristina Nicolosi
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Daniela Bacherini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Federica Soloperto
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Federica Sarati
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Dario Giattini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Giulio Vicini
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
- Azienda USL Toscana Nord Ovest, 56121 Pisa, Italy
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Tan NE, Wortz BT, Rosenberg ED, Radcliffe NM, Gupta PK. Impact of Heads-Up Display Use on Ophthalmologist Productivity, Wellness, and Musculoskeletal Symptoms: A Survey Study. J Curr Ophthalmol 2022; 34:305-311. [PMID: 36644468 PMCID: PMC9832462 DOI: 10.4103/joco.joco_115_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 12/11/2022] Open
Abstract
Purpose To explore how ophthalmologist productivity, wellness, and musculoskeletal (MSK) symptoms are affected by heads-up display (HUD) use. Methods A digital survey was emailed to the United States ophthalmologists. Questions covered topics including MSK health, surgical output, work hours, wellness hours, and factors related to HUD use. Results One hundred and forty-four ophthalmologists responded, and 99 completed all eligible questions. HUDs were utilized by 33 respondents, 29 of whom submitted complete surveys. HUD users worked 353 more hours annually (P = 0.01) and performed 673 more cases (P = 0.07) than nonusers. MSK symptom presence (P = 0.79), severity (P = 0.80), and frequency (P = 0.86) were independent of use. Over half (n = 16/29) of users identified symptomatic improvement attributable to the device, mostly in the cervical and lumbar regions. Mean job stress was moderate-severe for both users and nonusers (P = 0.10), and there was no significant difference in wellness hours (P = 0.44). Retina specialists (P = 0.02) and males (P = 0.03) were more likely to have operated with the technology. Nearly half of heads-up surgeons (n = 12/29) had obtained new equipment to target MSK symptoms, versus 1.4% of nonusers (n = 1/70; P = 0.0009). Most of those who operated with HUDs would recommend them to others (69.0%, n = 20/29), but 44.8% (n = 13/29) indicated ergonomic challenges. Primary concerns included awkward viewing angles, setup difficulties, and a lack of access. Conclusions HUD surgeons reported greater work output versus nonusers without significant compromises in wellness or MSK health. User feedback suggests that the technology may lessen neck and low back pains, but barriers including cost and system inconveniences may impede adoption.
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Affiliation(s)
- Nicholas E. Tan
- Department of Ophthalmology, College of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Brayden T. Wortz
- Department of Chemistry, Wake Forest University, Winston-Salem, NC, USA
| | - Eric D. Rosenberg
- Department of Ophthalmology, New York Medical College, Valhalla, NY, USA
| | - Nathan M. Radcliffe
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA,New York Eye Surgery Center, Bronx, NY, USA
| | - Preeya K. Gupta
- Triangle Eye Consultants, Raleigh, NC, USA,Tulane University, New Orleans, LA, USA,Address for correspondence: Preeya K. Gupta, 2075 Renaissance Park Pl, Cary, NC, USA. E-mail:
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Muecke TP, Casson RJ. Three-Dimensional Heads-up Display in Cataract Surgery: A Review. Asia Pac J Ophthalmol (Phila) 2022; 11:549-553. [PMID: 36417680 DOI: 10.1097/apo.0000000000000562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
Intraocular visualization in cataract surgery is currently achieved using the ophthalmic surgical microscope (OSM). Three-dimensional (3D) heads-up display is a burgeoning intraocular visualization technique for cataract surgery, which projects the surgical view to a 3D monitor. A number of theoretical advantages of this system over the OSM have been proposed. 3D visualization is reported to provide improved depth perception and the heads-up display promotes a more ergonomic surgical position while providing an enhanced view for the entire surgical team. The modern OSMs, however, already allow for safe and efficient cataract surgery, and 3D heads-up display visualization is limited by a steep learning curve. We critically review the literature around 3D heads-up display cataract surgery and compare its safety profile to traditional visualization techniques.
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Affiliation(s)
- Thomas P Muecke
- Ophthalmology Department, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Ophthalmology & Visual Science, University of Adelaide, Adelaide Health and Medical Sciences Building, Adelaide, SA, Australia
| | - Robert J Casson
- Ophthalmology Department, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Ophthalmology & Visual Science, University of Adelaide, Adelaide Health and Medical Sciences Building, Adelaide, SA, Australia
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Ripa M, Kopsacheilis N, Kanellopoulou K, Nomikarios M, Motta L. Three-Dimensional Heads-Up vs. Standard Operating Microscope for Cataract Surgery: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:2100. [PMID: 36140501 PMCID: PMC9497825 DOI: 10.3390/diagnostics12092100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The surgical time duration, the postoperative best-corrected visual acuity (BCVA), and the incidence rate of intraoperative complications, alongside the vision and posturing parameters, were estimated by systematic review and meta-analysis to compare the three-dimensional (3D) heads-up visualization system (HUVS) and standard operating microscope (SOM) in cataract surgery. METHODS A literature search was conducted using PubMed, Embase, and Scopus on 26 June 2022. The weighted mean difference (WMD) was used to present postoperative BCVA and the mean surgical time duration, whereas the risk ratio (RR) was used to present the incidence rate of intraoperative complications. Publication bias was evaluated with Egger's test. The Cochrane Collaboration's Tool for randomized clinical trials, the methodological index for non-randomized, and the Newcastle-Ottawa Scale were used to assess the risk of bias. The research has been registered with the PROSPERO database (identifier, CRD42022339186). RESULTS In the meta-analysis of five studies with 1021 participants, the pooled weighted mean difference (WMD) of the postoperative BCVA showed no significant difference between patients who underwent HUVS versus SOM cataract surgery (WMD = -0.01, 95% confidence interval (CI): -0.01 -0.02). In the meta-analysis of nine studies with 5505 participants, the pooled WMD of mean surgical time duration revealed no significant difference between patients who underwent HUVS versus SOM cataract surgery (WMD = 0.17, 95% CI: -0.43-0.76). In the meta-analysis of nine studies with 8609 participants, the pooled risk RR associated with intraoperative complications was 1.00 (95% CI, 1.00-1.01). CONCLUSIONS 3D HUVS and SOM provide comparable surgical time duration, postoperative BCVA, and incidence rate of intraoperative complications.
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Affiliation(s)
- Matteo Ripa
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Ophthalmology Unit, Catholic University “Sacro Cuore”, 00168 Rome, Italy
| | - Nikolaos Kopsacheilis
- East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital Ethelbert Road, Canterbury CT1 3NG, UK
| | - Kanellina Kanellopoulou
- East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital Ethelbert Road, Canterbury CT1 3NG, UK
| | - Mikes Nomikarios
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford TN24 0LZ, UK
| | - Lorenzo Motta
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford TN24 0LZ, UK
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Sandali O, Tahiri JHR, Armia Balamoun A, Duliere C, El Sanharawi M, Borderie V. Use of Black-and-White Digital Filters to Optimize Visualization in Cataract Surgery. J Clin Med 2022; 11:4056. [PMID: 35887820 PMCID: PMC9316540 DOI: 10.3390/jcm11144056] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate the effect of a black-and-white (BW) filter on the optimization of visualization at each stage of cataract surgery. METHODS Prospective, single-center, single-surgeon, consecutive case series of 40 patients undergoing cataract surgery with BW filter. Surgical images and videos were recorded with and without the BW filter at each stage of cataract surgery. Contrast measurements of surgical images and subjective analysis of video sequences were performed. RESULTS The surgeons assessed the BW filter to optimize the tissue visibility of capsulorhexis contours, hydrodissection fluid wave perception, the contrast of instruments through a nucleus during phaco-chop, and subincisional cortex contrast through the corneal edema. Despite the higher contrasts' value obtained with BW filter images during nucleus removal, posterior capsular polishing and viscous removal, the surgeons subjectively reported no significant advantage of using a BW filter. Standard color images were found to be better for localizing the limbal area during incision and for nucleus sculpture to assess groove depth. CONCLUSIONS In conclusion, we describe here the potential indications for BW filter use at particular stages in cataract surgery. A BW filter could be used, with caution, in cases of poor visualization.
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Affiliation(s)
- Otman Sandali
- Centre Hospitalier National d’Ophtalmologie des XV-XX, Research Team 968, Institut de la Vision, Pierre & Marie Curie University Paris 06, 75012 Paris, France;
- Service de Chirurgie Ambulatoire, Hôpital Guillaume-de-Varye, 18230 Bourges, France
| | | | - Ashraf Armia Balamoun
- Watany Eye Hospital (WEH), Cairo 11775, Egypt;
- Watany Research and Development Centre, Cairo 11775, Egypt
- Ashraf Armia Eye Clinic, Giza 12655, Egypt
| | | | - Mohamed El Sanharawi
- Service d’Ophtalmologie, Centre Hospitalier de Châteaudun, 28200 Châteaudun, France;
| | - Vincent Borderie
- Centre Hospitalier National d’Ophtalmologie des XV-XX, Research Team 968, Institut de la Vision, Pierre & Marie Curie University Paris 06, 75012 Paris, France;
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Comment on: Efficacy of 3D digital visualization in minimizing coaxial illumination and phototoxic potential in cataract surgery: pilot study. J Cataract Refract Surg 2021; 47:974. [PMID: 34173392 DOI: 10.1097/j.jcrs.0000000000000698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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